Senate Democrats cleared their 60-vote margin to cut off the health care debate early Monday morning, with hopes of casting a vote for final passage of their legislation on Christmas Eve.
The vote, held shortly after 1 a.m. Monday, was the most significant procedural hurdle Democratic leaders faced on President Obama’s top legislative priority. Democrats predicted on Saturday they would have enough support, but pumped fists and shook hands as the 60-40 tally, divided along party lines, was announced.
Democrats said the successful first vote all but assures final passage.
“The die is cast,” said Sen. Charles E. Schumer, New York Democrat. “It’s done.”
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Many Democrats said ahead of the vote that the legislation isn’t perfect — some wanted the public insurance plan; others wanted more cost-cutting measures, for instance — but they unified to move along with their hopes of providing insurance coverage to millions of more Americans.
“Today, the Senate took another historic step toward our goal of delivering access to quality, affordable health care to all Americans,” Majority Leader Harry Reid, Nevada Democrat, said after the vote.
On hand for the vote was Victoria Reggie Kennedy, whose late husband, Sen. Edward M. Kennedy, was one of the Senate’s chief reform proponents, as well as Health and Human Services Secretary Kathleen Sebelius and health “czar” Nancy-Ann DeParle.
Both supporters and opponents called the vote one of the most historic in recent Senate history. Sen. Tom Harkin, Iowa Democrat and chairman of the Health, Education, Labor and Pensions Committee, called it a “pivotal point in the decades-long request to pass comprehensive health care reform.”
“We reached a crossroads, a point in time just like this Senate did in 1935 when we passed Social Security or in 1965 when we passed the Medicare bill,” he said on the Senate floor shortly before the vote. “Each of those bills was a giant step forward for the American people.”
Republicans opposed the legislation all along over concern that it would raise taxes and insurance premiums, cut Medicare funding and put the government between doctors and patients. They had hoped to block or stall the vote, but ran out of procedural options in the closing days.
“History in our future generations will judge us on this vote,” warned Sen. Orrin G. Hatch, Utah Republican, on the Senate floor. He labeled the vote as one “that will fundamentally change the American landscape for generations to come and restructure one-sixth of our American economy. A vote that will determine if we give our future generations the same opportunities and the same set of pride that has been our privilege. Make no mistake, our actions on this vote will not be without consequences.”
The legislation would extend coverage to 31 million new Americans, try to stop insurance company abuses, give low- and middle-income Americans tax credits to help them buy coverage and establish an independent board to keep Medicare solvent.
In the search for compromise to reach 60 votes, the bill doesn’t have the public insurance plan or the Medicare expansion for which Democrats had been hoping.
More procedural votes are planned for Tuesday morning and Wednesday afternoon, but Democrats are expected to hang on to their supermajority. The vote for final passage, expected at about 7 p.m. Christmas Eve, will require only 51 votes.
The odd timing is because Senate rules require at least one calendar day and an hour between the time the so-called “cloture” vote is requested and when it is held. Democrats could have postponed the vote until normal business hours, but that would have delayed the procedural votes between now and the final vote, pushing them into Christmas Day.
With Democrats announcing Saturday that they appear to have support from all 60 members of their caucus, just enough votes to overcome the procedural measures, Republicans appeared all but defeated in a Sunday-afternoon press conference. There are no procedural measures left for them to stop the bill, only delay it, short of a Democrat having second thoughts on the legislation.
“People have to show up; they have to vote,” Minority Leader Mitch McConnell, Kentucky Republican, said Sunday afternoon. “They have to take ownership” of the legislation.
If the bill passes the Senate, as expected, it still has to be merged with the House’s reform bill. The House has a public insurance plan and restrictions on abortion access that the Senate bill doesn’t, and both will have to be resolved while maintaining support in both chambers.
“This is not over by any stretch,” Mr. McConnell said.
Under the Senate’s plan, a series of insurance industry reforms would be enacted in about six months. Insurance companies wouldn’t be able to deny children coverage because of a pre-existing condition or drop any patient because they get sick, for instance. Tax credits would go into effect immediately to help small businesses — those with average wages of up to $50,000 — buy coverage. Large employers would have to provide coverage or face fines.
Insurance would only be available on the exchanges established under the bill in 2011. The Office of Personnel Management, which operates federal employees’ health plan, would help create two national or multistate health plans to exist alongside private plans.
The most expensive insurance plans would be taxed to help pay for reform. Those plans valued at more than $8,500 for individuals or $23,000 for a family would face a 40 percent tax. People who make more than $200,000 — or couples who make more than $250,000 — would face new Medicare payroll taxes as well.
In 2014, most Americans would have to buy insurance coverage or face a penalty that would increase yearly — up to $750 in 2016 — or 2 percent of their income. To help them buy coverage, people who make up to 400 percent of the federal poverty level — which comes to $88,200 for a family of four in 2009 — would get tax credits. More of the poor would be able to get on Medicaid.
The bill also includes a series of carve-outs targeted at specific states or programs in what Republicans said was a blatant attempt to buy votes.
For example, the federal government will pick up Nebraska’s tab to expand the Medicaid program while other states will have to eat their own costs. Sen. Ben Nelson, a Democrat who represents the state, was the last party member to announce his support.
“This process is not legislating; this process is corruption,” said Sen. Tom Coburn, Oklahoma Republican. “It’s a shame the only way we can come to a consensus in this country is to buy votes.”
On Sunday, Mr. Nelson defended the concession he won on Medicaid funding, which would be worth $45 million to his state over 10 years, saying Nebraska’s Republican governor had expressed concerns over the expanded Medicaid costs.
Gov. Dave Heineman said in a statement later Sunday that all he did was agree with Mr. Nelson that the Medicaid funding was “another unfunded federal mandate” that would hurt the state’s budget and “something that has to be fixed.” But “I didn’t participate in the way it was fixed,” he said, calling the bill “bad news for Nebraska and bad news for America.”
“Nebraskans did not ask for a special deal, only a fair deal,” he said.
Public opinion has sharply turned against the legislation as the debate has dragged on for more than a year.
A CNN/Opinion Research Corp. poll done earlier this month — before the public option was removed — found that only 36 percent of Americans favor the Senate’s bill and 61 percent oppose. That’s down from 46 percent favoring the bill a month before.
Democrats argue that polls will reverse once the public understands what is in their plan.
“Politics follows good policy,” Sen. Max Baucus, Montana Democrat and Finance Committee chairman, said last week after a meeting between Mr. Obama and the Democratic Caucus.
Democrats started the health reform conversations with hopes of establishing a public insurance plan, a government-run insurance program to compete with private insurers.
For months, liberal Democrats argued that it was the only tool strong enough to force private insurers to keep prices low. Some on Capitol Hill argued that Mr. Obama didn’t do enough to keep the provision in the legislation.
While it passed in the House, there wasn’t enough support in the Senate, forcing Mr. Reid to take the public plan out of the bill in order to reach 60 votes.
Some Democrats at the most liberal end of the spectrum, particularly former Democratic National Committee Chairman Howard Dean, argued that the bill is so weak without the public option that it’s not worth passing.
Sen. Russ Feingold, Wisconsin Democrat and supporter of the public option, said losing the provision was difficult, particularly because of “lack of support from the administration,” but he will support the bill.
“On balance, the bill still delivers meaningful reform, and the cost of inaction is simply too high,” he said in a statement Sunday. “This bill significantly expands coverage and helps protect Wisconsinites from high costs and insurance company abuses, such as denying or restricting coverage based on pre-existing conditions.”
“Obviously, the public-plan option is the one that has gotten the most attention,” said Ron Pollack, executive director of Families USA, a health-care advocacy group that supports the Democrats’ bill. “We thought it made the most sense, and we thought, if set up in a robust manner, would drive down costs, because it would compete with private insurance companies. There is so much in this bill that i think is way overdue. If we fail to get those other things, I think affordability of health care is only going ot get worse and worse.”
Democrats argue that they view the bill as a framework to be repaired and built up in later years.
Mr. Harkin said the legislation isn’t the “mansion” liberals had hoped for, but a “starter home” with “room for expansion.”